The Sad Case of the Patient Protection and Affordable Care Act

[Rover]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I don't share Sullivan (or Kep's) optimism. A long long long long time ago in a galaxy far away (cue the Star Wars theme) electoral defeat would bring about change. The problem is that there's no incentive anymore to build a lasting legacy in public service. Far better to stick to the script, lose, and then hit the Fox News or lobbying circuit. Who's made out better recently, Sarah Palin or Richard Lugar? How much longer until you think Michelle Bachman ditches Congess for a million dollar TV or radio gig?

As long as its more lucrative to be a bomb thrower than a pragmatist, there's no incentive for the vast majority of Republican officeholders to suddenly revert back to "traditional conservatism".

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I think it will have a couple of advantages. First off, traditional conservatism is an incredibly well thought-out philosophy. Burke, Kirk, and Oakeshott (and dozens of other interesting people from economists to poets) have written voluminously on it and from many different angles. Secondly, I think the left's identity crisis will give traditional conservatism an open field for a while.

This is very good news because at its best traditional conservatism, besides being a source of obvious stability, tends also to great legitimacy -- even its opponents recognize it is an actual pillar of thought. It also tends not to be provocative. It is also a very good base from which to defend against attacks from without, because it fosters group identity rather than divisiveness (this is one of the great indicators of true conservatism: it stresses that what unites us is stronger than what divides us). It isn't very good about pivoting to new situations, but that's where the other great piston, the Progressives, eventually kicks in.

I had to blink twice and rub my eyes when I read this. So Milton Friedman's Capitalism and Freedom and Hayek and yes even Adam Smith are worth reading after all?



and it looks like traditional conservatism has quite a bit of popular appeal: see Christie in NJ for example. He is nowhere near the far right; one of those suspect RINOs to the "purists" who have hijacked the party's right wing.

[amherstblackbear]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I had to blink twice and rub my eyes when I read this. So Milton Friedman's Capitalism and Freedom and Hayek and yes even Adam Smith are worth reading after all?

Well, I'd put it Adam Smith, Hayek, and yes even Friedman.

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Well, I'd put it Adam Smith, Hayek, and yes even Friedman.

Smith is worth reading but he is not conservatism, he's market capitalism (not at all the same thing -- in fact, conservatives spent the 19th century opposing market capitalism as a disruptive new-fangled fad, same as they opposed extending the franchise).

Half the time Hayek is the militant wing of Austrian school. I wouldn't include him as a great thinker, though he is an entertaining read, which not many economists can say. (Sorry Libertarians. You have not yet produced your great thinker. Please check your Von Mises tinfoil hats at the door.)

Friedman I don't know much about, but I know enough that I would advise contemporary economic conservatives not to cuddle with him too closely. Like Buckley, he is not the droid you're looking for.

Coleridge and Eliot are often cited as truly great conservative thinkers and writers. Again, I don't know enough to comment.

Here is a Wikipedia entry on the subject, for all that entails good and bad.

Key principles

1. Natural law and transcendent moral order: Belief in natural law and transcendent moral order lay the foundation for traditionalist conservative thought. Reason and Divine Revelation inform natural law and the universal truths of faith. It is through these universal truths of faith that man orders himself and the world around him. ...

2. Tradition and custom: As the name suggests, traditionalists believe that tradition and custom guide man and his worldview. Each generation inherits the experience and culture of its ancestors and through convention and precedence man is able to inherit the culture of his ancestors and pass it down to his descendants. To paraphrase Edmund Burke, often regarded as the father of modern conservatism: "The individual is foolish, but the species is wise."

3. Hierarchy and organic unity: Traditionalist conservatives believe that human society is essentially hierarchical (i.e., it always involves various interdependent inequalities, degrees, and classes and that political structures that recognize this fact prove the most just, thriving, and generally beneficial). Hierarchy allows for the preservation of the whole community simultaneously, instead of protecting one part at the expense of the others.

4. Agrarianism: While most traditionalist conservatives are cosmopolitan and many live in urban centers, the countryside and the values of rural life are prized highly (sometimes even being romanticized, as in pastoral poetry). The principles of agrarianism (i.e., preserving the small family farm, open land, the conservation of natural resource, and stewardship of the land) are central to a traditionalist's understanding of rural life.

5. Classicism and high culture: Traditionalists defend classical Western civilization, and value an education informed by the texts of the Hebraic, Greek, Roman, and Medieval eras. Similarly, traditionalists are classicists who revere high culture in all of its manifestations (e.g., literature, music, architecture, art, theater). Likewise, traditionalists keep away from low culture and popular culture, as well as what they regard as lies of high culture such as modernism.

6. Patriotism, localism, and regionalism:Unlike nationalists, who esteem the role of the State or nation over the local or regional community, traditionalists hold up patriotism as a key principle. Traditionalist conservatives think that loyalty to a locality or region is more central than any commitment to a larger political entity. Traditionalists also welcome the value of subsidiarity and the intimacy of one's community. Nationalism, alternately, leads to jingoism and views the state as abstract from the local community and family structure rather than as an outgrowth of these local realities.

[amherstblackbear]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Smith's Theory of Moral Sentiments is one of the more underread works around, and an antidote to Smith=market. All the more reason he needs to be at the top of the list. Hayek's not a politico, but he is a Nobel laureate. Friedman may be the easiest to translate into partisan ideology, but he's also the lightweight in that trio. Maybe not coincidentally.

Smith is worth reading but he is not conservatism, he's market capitalism (not at all the same thing -- in fact, conservatives spent the 19th century opposing market capitalism as a disruptive new-fangled fad, same as they opposed extending the franchise).

Half the time Hayek is the militant wing of Austrian school. I wouldn't include him as a great thinker. (Sorry Libertarians. You have not yet produced your great thinker.)

Friedman I don't know much about, but I know enough that I would advise contemporary economic conservatives not to cuddle with him too closely. Like Buckley, he is not the droid you're looking for.

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Smith's Theory of Moral Sentiments is one of the more underread works around, and an antidote to Smith=market. All the more reason he needs to be at the top of the list.

I will defer to those who know more about it than I. (Another conservative sentiment utterly ignored by the modern right.)

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I will defer to those who know more about it than I. (Another conservative sentiment utterly ignored by the modern right.)

very refreshing to hear someone not a conservative point out that there is little relationship today between philosophical conservatism and the Repugnican party!



I'd also suggest that there is little relationship today between philosopical liberalism and the Dummycrat party as well.

[joecct]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Really?

We have reams of data that say that early diagnosis of illnesses is cheaper in the long run. This helps that cause. Isn't that a conservative thing to do?

Conservatism is incremental change. Look @ the problem, study some alternatives and implement A. If A works, and there is still a problem, then study some more and implement B. Conservatives do not want to throw the baby out with the bathwater. The ACA was a jumble of everything from Plan A - Plan Z. Something in there will work, some of it is going to be an abject disaster.

Liberalism tends to want to solve the whole shebang right now.

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Conservatism is incremental change.

*****http://rlv.zcache.com/very_gradual_change_we_can_believe_in_poster-re053990fb18244368b6b2b2f0fd656da_wx5_400.jpg******

[ScoobyDoo]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Conservatism is incremental change. Look @ the problem, study some alternatives and implement A. If A works, and there is still a problem, then study some more and implement B. Conservatives do not want to throw the baby out with the bathwater. The ACA was a jumble of everything from Plan A - Plan Z. Something in there will work, some of it is going to be an abject disaster.

Liberalism tends to want to solve the whole shebang right now.

Hardly. The logical conclusion is Universal Care. This doesn't even come close.

[amherstblackbear]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I will defer to those who know more about it than I. (Another conservative sentiment utterly ignored by the modern right.)

My background is more in economics than in political philosophy (which, I'm guessing, you know more about than I do). In philosophical terms, there may be better (by whatever criteria) expressions of modern Liberal thought than Smith's.

What makes Theory of Moral Sentiments interesting is to have a systematic view of the sort of society assumed (but not explained) in Wealth of Nations.

The standard classroom moves are: "How close/far is ToMS to describing contemporary society?" followed by the thought experiment: "What, if anything, would Smith modify in Wealth given a different view of society?"

It may be a pedagogical cliche, but it's a cliche for a reason. Smith completely outclasses folks like Friedman/Keynes in terms of being thought-provoking. IMO.

@Kepler

Yeah, I know. I originally posted in the wrong thread. Fail.

To respond here, anyway: I was just riffing on FF's choices (and inadvertently expressing a preference on the theoretical/applied divide).

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Smith completely outclasses folks like Friedman/Keynes in terms of being thought-provoking. IMO.

Is that a fair comparison, though? Friedman and Keynes were trying to solve specific problems. Smith was a general theorist.

Isn't it like saying "Galileo outclassed Kepler as an astronomer?" Different focus.

[ScoobyDoo]

Re: The Sad Case of the Patient Protection and Affordable Care Act

My favorite news item of the day:

Texas Gov. Rick Perry, joining with several other Republican governors, said Monday that he would not expand Medicaid programs, taking advantage of one element of the Supreme Court’s ruling last week that upheld the Affordable Care Act’s individual mandate but also allowed states to opt out of the law's Medicaid expansion.

Healthcare in Texas is currently deemed “weak” for a number of reasons by the Agency for Healthcare Research and Quality, a branch of the DHHS. Texas also boasts the highest percentage of uninsured residents in the country, at 27.6%.

http://www.latimes.com/news/politics...,6752534.story

Be strong, Rick. Be strong.

[5mn_Major]

Re: The Sad Case of the Patient Protection and Affordable Care Act

My favorite news item of the day:

http://www.latimes.com/news/politics...,6752534.story

Be strong, Rick. Be strong.

Other prominent Republican governors, including Florida’s Rick Scott, Louisiana’s Bobby Jindal, South Carolina’s Nikki Haley and Wisconsin’s Scott Walker, have previously declared their states would opt out of President Obama’s healthcare law.

There are currently no written penalties here...and it didn't take long for them to bail on our foundational blueprint. You can tell just how important the US Constitution is to a politician if they have the option to ignore it and do so.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I was asked to provide more detail regarding my assertion that actuarially, the way Roberts reinterpreted the PPACA pretty much ensured it could not work.

Also, in this particular post, I am limiting my comments only to the actual contents of the law itself. There are better ways to accomplish what the law purports to achieve. As I said in the original post, no matter what you believe about what health care coverage should be, this particular law fails to deliver.

It's faded into the background now, earlier this year something like 811 waivers were granted for so-called "mini-med" programs (like McDonalds offers, for example). One detail of the law prescribes how much of an insurer's premium income has to be paid out in claims (the "loss ratio"). Someone staffer apparently read a few articles and noted that the market tends toward an 85% loss ratio over time in certain plan designs (i.e., if premium income is $1,000,000 then claims payments are $850,000). This trend comes about due to competitive pressure in the marketplace. Insurance companies have a target return on capital, and a long-term loss ratio under 80% brings price competition to bear.

So this bright staffer, earnest, well-meaning, and lacking experience and wisdom, decides to encode this information into statute. Two huge problems, one immediate, and one latent.

The immediate problem of course was mini-med plans. Partly because the plans have a relatively low benefit limit, and partly because of the populations they serve, mini-med plans necessarily require more administration, while the maximum claim is relatively lower....mini-med plans typically have a loss ratio of about 65%, which is "appropriate" for that plan design. However, the law specifies an 80% loss ratio in any one year. Had the law been admnistered as written, it would have resulted in a loss of coverage for quite a few people who are served by the existing coverage. To insulate itself from the political fallout, waivers were granted left and right.

The deeper problem is more insidious. Loss ratios really should be some kind of rolling average over time, because there is always a one-year time lag between the time a premium rate is set and the time at which the insurance company has to pay the claims. I'll set aside the distinction between "manual rates" and "experience rating" in setting premiums for another time. However, loss ratios in excess of 100% are not all that unusual....companies insuring Wall Street firms in 2007 - 2008 saw a huge spike in mental and nervous claims, for example, I think one company had a 132% loss ratio on one block of business.

However, the law does not provide for any kind of smoothing over time. Each year, the loss ratio has to be no less than 80% or else premiums have to be refunded to make up the difference. So you can lose money if you have a bad year, but you cannot make money if you have a good year.

On top of that, everyone agreed that you needed the mandate to make it possible for insurers to offer cover without pricing in the appropriate level of risk for people who already are sick (imagine for a minute a homeowners insurance law that requires insurance companies to provide coverage for a building that is already on fire!!). Only by spreading the risk over a large enough pool of healthy people can you get that incremental spread you need from each one to cover the concentrated risk from unhealthy insureds. However, the mandate has been ruled unconstitutional. It was reframed as an "option" in order to allow the law to stand under an alternative interpretation: you can either pay a tax or buy insurance, except the tax is often much less. This ruling subverts the intention of the law while allowing the shell to stand anyway. If people try to skate on coverage thinking they'll just buy insurance once they get sick, they will find that coverage still does not apply retroactively.


A relatively minor tweak would have been so much better. Rather than merely require pre-existing conditions be covered upon demand, you have an open enrollment window once every two years, say...anyone who wants to buy coverage can during that window, otherwise you still have to qualify until the next window opens. Incentives matter. This particular law is resoundingly stupid in so many different ways.